Directional coronary atherectomy: but wait, there's more.

Abstract

Directional coronary atherectomy (DCA) was originally developed as a potential replacement for balloon angioplasty. The design of the catheter used to perform DCA offered several unique advantages. First, it was capable of removing obstructive atherosclerotic lesions. Thus rather than rearranging plaque within an artery as occurs with balloon angioplasty, the obstruction was relieved by reduction of the plaque mass. Second, certain lesions with characteristics unfavorable for balloon angioplasty appeared to be ideally suited for DCA. Since the atherectomy catheter had a cutting window that could be positioned rotationally as well as longitudinally within an artery, eccentric plaque could be removed selectively. Similar benefits were anticipated from lesions located at important coronary bifurcations, such as those involving the left anterior descending coronary artery and origin of the diagonal branch. Finally, tissue removed by DCA was available for analysis to expand our knowledge about coronary atherosclerosis. Samples of coronary atheroma could be examined grossly and microscopically1 and studied by immunohistochemistry.2 Initially, the value of DCA was assessed by means of a large registry that catalogued acute and late clinical outcomes.3 When compared with a historical control, the results of DCA appeared comparable to or better than those achieved by balloon angioplasty. There was a sense that the incidence of serious coronary dissection and abrupt occlusion after DCA was less than that after balloon angioplasty.4 DCA became the first of the “new” percutaneous, catheter-based devices approved for the treatment of coronary disease in the United States. Interestingly, unlike current “new devices,” approval did not require the performance of a randomized, clinical trial. DCA was quickly and enthusiastically embraced by the interventional community. During this early phase of its use, DCA was performed without adjunctive balloon angioplasty; that is, the DCA catheter was used alone and not …